Give me one good reason why basic eye exams can’t already be done by a robot.
Mar 13 2014
Harvard's Sendhil Mullainathan has a remarkable life story. From a profile in Forbes:Born in a small farming village in India, Mullainathan lived there for seven years while his father moved to the U.S. to go to graduate school. On his fifth birthday, his father sent him a three-piece suit. On the way, via oxc...
Mar 12 2014
It is a mistake to say that Adam Smith unambiguously favored retaliatory tariffs. Russ Roberts called my attention to a mistake in my bio of Adam Smith in The Concise Encyclopedia of Economics. I had bought the conventional wisdom on Smith, which was that he favored retaliatory tariffs. That's why I wrote: One defin...
Mar 12 2014
Give me one good reason why basic eye exams can't already be done by a robot. Written while waiting for a human with an M.D. to repeatedly ask me "Better like this... or like that?"
READER COMMENTS
Ian Brown
Mar 12 2014 at 10:39am
First Online Eye Exam that writes you a prescription:
http://techcrunch.com/2014/02/25/do-i-need-glasses/
Hugh
Mar 12 2014 at 10:55am
1) You can’t discuss the results afterwards with a robot;
2) Robots make poor salesmen for high-end frames for glasses.
Richard Manns
Mar 12 2014 at 11:04am
Well, depends on what you mean by ‘basic’. By the bye, you’re likely to be talking to an OD, rather than an MD, in the US.
In terms of refraction, an auto-refractor will do that, but it is not as accurate as humans are, and you’ll get a dose of cycloplegic in your eye, that will stop you from drive for a few hours at best. They are often used as a starting point for optometrists more-accurate subjective testing, in people who cannot communicate, and in mass screening programmes. But even the best auto-refractors are not as good as humans using the relatively rough-and-ready retinoscopy (before you get to the – https://www.ncbi.nlm.nih.gov/pubmed/15630406
In terms of eye disease screening (at least, that’s what British optometrists do), no robot is close.
In summary, the auto-refractors of today are not very good at what they do, and don’t do the rest. But would it be good enough for you?
nl7
Mar 12 2014 at 11:25am
Customer service suggests it might be more comfortable for some people to do it with a person, particularly technophobes, seniors, or those with disabilities. But other people would probably prefer to do it without a person, which may produce some marginal embarrassment.
I know that it causes me to feel a little pressure to get it right, since the other person is 100% waiting for me. A robot doesn’t care how long I take, so I can be neurotic and take a while or go back if I want to do it again.
No particular reason for a specialist to be involved at this stage. Just like you don’t technically need a nurse to take your BP or temperature or height, but they do. For the time being it may be simpler, since they have certain nurse staffing needs anyway. As costs of robots continue to fall, it’s almost inevitable that they will be involved in the near future, even if optometrists and nurses are notionally operating them.
MG
Mar 12 2014 at 11:40am
I am not even sure this is the “hurdle” here.
For me the pertinent question is: “Give me one good reason why basic eye exams can’t already be done by a smart phone app? There are already prototypes of this, and we will see how well they work. This is more of an “end game”, since the biggest cost to routine eye eyams is wasting 1.5-2.0 hrs getting to/back and sitting through a site visit – with or without a human doing the test.
Wojtek Grabski
Mar 12 2014 at 11:49am
You can. In Ontario anyway, we have the choice of either seeing an optometrist or an opthalmologist – a well functioning and non-covered market. optometrists use these large instruments that spit out the prescription in under a minute – it’s nearly free. Ophthalmologists, generally seen by people with disease or with ritzy insurance, take forever and still do it all by hand. When it comes to simple vision tests, they’re claims generation robots. The contrast is in service is astounding.
Despite the speculation above, the optometrist is perfectly happy to spend time going over frames after the incredibly short test — which they hope to subsidize with the sale. Ophthalmologists often don’t sell frames, that time can be spent racking up billings.
Thankfully the market did open when the province stopped making it “free”, so now we can get an exam by walk-in at a moment’s notice at what seems like every major intersection. This should be a lesson for the world, but most people are too anti capitalist to acknowlede it.
The only remaining problem, and it’s a big one, is that a vast majority of people are entitled, through work insurance, to a new set of 500 dollar frames every two years. The impact this has on prices is obvious.
William Newman
Mar 12 2014 at 11:54am
It takes a certified medical school to do it, and we seem to have largely lost the political technology to create certified medical schools even for humans, so unless you can find an existing certified medical school for robots that was grandfathered in, perhaps it is simply impossible.
RPLong
Mar 12 2014 at 12:01pm
Because the concept hinges on the word “basic.” Caplan may be right or wrong, depending on what he means. It has nothing to do with what the robot can or can’t do.
silly sailor
Mar 12 2014 at 12:01pm
Rent seeking by opticians
ColoComment
Mar 12 2014 at 12:07pm
I’d be more interested in why so many humans need vision correction. I’d guess that 50% of the population (if not more), exclusive of age-related presbyopia, wear some kind of corrective lenses or have had corrective surgery.
Have humans always been this vision deficient? Is this just a faulty design or is it primarily our modern, industrialized environment that has generated this need?
Patrick R. Sullivan
Mar 12 2014 at 12:13pm
If we can ‘Rolls alone’ on the ocean blue, we can do just about anything with robots (or automation).
Curtis L.
Mar 12 2014 at 12:30pm
Malpractice suits for the robot missing something it wasn’t programmed to find.
Jon
Mar 12 2014 at 12:46pm
Because optometrists also check eye health to ensure you don’t have problems like macular degeneration, etc… I’m not sure robots can be trusted with this yet.
One step in this direction would be to have some of the routine operations covered by robotics while the optometrist assesses the results afterwards.
Jess Riedel
Mar 12 2014 at 1:25pm
For those who mention screening for eye diseases: I think most (all?) of the screening methods use some sort of device that you look into, and the doctor looking into the other end. You could insert a high resolution video camera and have all of this done remotely (and therefore more efficiently and cheaper). This kind of remote assessment of imaging already occurs with radiology (e.g. x-ray reading), apparently called “teleradiology”.
http://www.advisory.com/research/imaging-performance-partnership/the-reading-room/2012/11/the-ins-and-outs-of-todays-remote-radiology-market
If you combine this with a robot that determines your prescription, you really should be able to eliminate the doctor from nearly everyone’s visit. The only people who will need to see a live human are those who are flagged as possibly having a disease.
On the other hand, I’ve often gotten my eye check ups at Walmart. It’s not as cheap as a robot, but it’s darn close.
Arthur_500
Mar 12 2014 at 1:31pm
Monopoly
Doctors fought, but lost, to the idea of Nurse Practitioners doing many of the basic doctor visits and writing prescriptions. However, now they demand a doctorate in order to qualify as a nurse practitioner so that will drive up the cost, reduce the value of a nurse practitioner to the patient and keep the value of the medical doctor high.
Most of what an optometrist does can be done by someone well-trained but not educated as a doctor. Some things currently are being done by office personnel. However, if you were to open the floodgates of non-certified persons doing such tasks then you would de-value the optometrist.
The cost to become an optometrist doesn’t go down but the revenue would. Therefore you need a monopolistic barrier to entry to keep the revenue stream adequate to support the profession.
Les Cargill
Mar 12 2014 at 1:45pm
http://en.wikipedia.org/wiki/Therac-25
Brett Champion
Mar 12 2014 at 2:11pm
Because robots have yet to master the very subtle skill of telling corny jokes.
Wojtek
Mar 12 2014 at 2:15pm
Les, what does this have to do with anything? Vision tests are optical.
This is like that cliché argument doctors always make: “What if someone comes into a pharmacy with a stomach ache and it’s actually a burst appendix!” I think WebMD has proved anyone can be just as much a hypochondriac as the next person.
Anyway:
http://www.eyeglassguide.ca/my-visit/vision-testing/autorefractor.aspx
Rob
Mar 12 2014 at 2:17pm
You’re probably right, there probably isn’t a technical constraint to robots administering eye tests.
But show me a robot that says “like this and like that and like this and uh” more entertainingly than these humans.
David C
Mar 12 2014 at 2:47pm
As Wojtek mentioned, in Canada, you have other options. And if you have no reason to suspect your vision has changed, you can also order online from Canada without a prescription. And that practice, to my knowledge, is decriminalized though not perfectly legal.
Jeff
Mar 12 2014 at 3:51pm
To follow up on the rent seeking: why do you need a prescription (in most states) to order eye glasses?
P.S. Also there are already machines that tell you your vision. I believe Zeiss has a machine that maps your eye and can provide more precise correction than the usual half-diopter steps. (So yes a robot can already do it better).
Hazel Meade
Mar 12 2014 at 4:26pm
One of the sick things about the US optometry industry in the US is that optometrists will generally refuse to tell you your pupil distance or provide it as part of your prescription. This effectively forces you to purchase a pair of eyeglasses from a brick-and-mortar store. Which usually biases people towards buying from the often-adjacent (though legally separate) frame store.
In order to buy online, you have to know yur pupil distance, or your glasses won’t work right. But good luck getting the optomotrist at Lenscrafters to tell you.
MingoV
Mar 12 2014 at 5:52pm
Ophthalmologists usually leave routine eye exams to optometrists.
Ophthalmologists do more advanced exams that include dilation of the pupils and fundoscopic exams of the retinas. The list of conditions that cause abnormal fundoscopic exams is long. Today’s robots are not good enough to identify AND interpret retinal abnormalities.
Silas Barta
Mar 12 2014 at 6:00pm
“Robot” might be pushing it. An easier threshold to discuss might be “lightly-trained worker”.
RPLong
Mar 12 2014 at 6:07pm
24 comments to date, and not a single “optimal-ogist” joke… tsk, tsk…
John T. Kennedy
Mar 13 2014 at 7:23am
[Comment removed pending confirmation of email address. Email the webmaster@econlib.org to request restoring your comment privileges. We have attempted to contact you previously. We’d be happy to publish your comment. A valid email address is nevertheless required to post comments on EconLog and EconTalk.–Econlib Ed.]
Finch
Mar 13 2014 at 9:36am
There are only around 25,000 ophthalmologists in the US. The market is not that big relative to the technological level and quality control required, so it will generally be slow to attract R&D dollars. It will progress, but not at a really high rate.
It’s not like inventing the next top-selling drug where the money will poor in. It’s like inventing the next large marine diesel fuel injection system. There’s a market, and it will get done, but there’s not much reason to spend what would be necessary to hurry it.
geoih
Mar 14 2014 at 7:04am
Because it’s more profitable to invest in the labor of a human versus investing in the capital to create and maintain robots, based on the projected earnings.
Duh. I thought this was an economics blog.
patri friedman
Mar 24 2014 at 8:14pm
Because optometrists are an entrenched, concentrated interest group. To compete with them, robot manufacturers would need to somehow exert greater political pressure, despite not yet being allowed to sell a product. as with most disruptive technologies, the key is primarily regulatory hacking and clever stealthing from the targeted industry and associated interest group.
As an aside, I find it somewhat frustrating when professional economists ignore public choice. It is extremely good at answering most questions about bad regulation that I see econbloggers post.
Comments are closed.